Posts Tagged ‘diabetes’

Living Solo Can Be Hazardous to Your Health

Monday, June 25th, 2012

Living to a ripe old age may depend on a person’s relationship to family, friends and community, according to research that finds lonely older adults are more likely to die sooner than their more socially active peers.  Lonely people who are 60 and older tend to have a 45 percent higher risk of dying over the next six years, according to research in the Archives of Internal Medicine.  Another study showed that people who live alone and had heart disease were 25 percent more likely to die from the illness.

Approximately one in seven Americans live by themselves.  The first study to examine the link between social isolation and death points to the importance of addressing psychosocial needs along with medical ones in improving the health of older adults, according to Carla Perissinotto, a study author.  “We cannot continue to ignore the other things that are happening in people’s lives,” said Perissinotto, an assistant professor of medicine and geriatrics at the University of California San Francisco.  “If we turn a blind eye to what our patients are experiencing at home, we may be missing a place to make a difference in someone’s health.”

The lonely people studied were more likely to have limited mobility and greater difficulty performing basic tasks like grooming and cleaning.  Approximately 25 percent of lonely people were likely to develop trouble compared to 13 percent who weren’t lonely.  While the connection between well-being and friendships isn’t new, the latest findings look specifically at people who self-identified as lonely, regardless of how extensive their social network.  “It’s about connectivity,” Carla M. Perissinotto said.  “Someone can have multiple social contacts but still somehow feel that they’re not connecting.”

One study followed nearly 45,000 people aged 45 and older who suffered from heart disease or had a high risk of developing it.  Those who lived alone were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.  The risk was highest in middle-aged people, just 14 percent of whom lived alone. Solo living increased the risk of heart problems and early death by 24 percent among people ages 45 to 65, and by only 12 percent among people ages 66 to 80.  And there was no association at all in people age 80 and older, a group in which living alone is widespread.

Additional research is needed to confirm the findings, but it may not be a bad idea for physicians to ask heart patients about their living situation, said senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.  Living solo “could be a little red flag that a patient may be at a higher risk of bad outcomes,” Bhatt said.  But living alone could impact health in more immediate ways.  For example, people who live along may skip their medications or ignore the warning signs of heart trouble, according to Bhatt.

Bhatt notes that patients who live alone should never ignore changes that might be a sign of health problems.  “Many times people just adapt to their circumstances.  Perhaps just lower your threshold a little bit and realize it’s better to call (the doctor) than not to call.”  That might not be the entire story.  “Other mechanisms by which living alone could increase cardiac risk have to do with possible social isolation and loneliness, and these are more challenging to fix,” he said.

According to Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, “Living alone, in and of itself, could stand for many different things.  Does it mean you lack companionship?  Or is it that there is no one there to help you out with medications?  Does it have to do with mobility or nutrition?”

Writing in Time, Alice Park notes that “Loneliness can be detrimental in many ways, some of which are biological and some of which are more behavioral.  Feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis.  Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own healthcare — which can in turn contribute to disability and early death.  Which is why the researchers were particularly concerned over another finding — many of the elderly who said they felt lonely were not actually living alone.

Rather, they were married or living with family members.  That suggests that the size of a person’s social network isn’t the only measure of loneliness, and that studies that look only at the number of people’s contacts may miss an entirely separate factor that can have a significant impact on health, said Perissinotto.  ‘I think that from a public health and policy level, we are doing a disservice by not asking (people) about their subjective feelings of loneliness.  We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?’”

Loneliness is a common source of suffering in older persons,” according to the study’s authors.  “We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline.  Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice.  However, loneliness may be an important predictor of adverse health outcomes as many traditional medical risk factors.  Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes.”

As Many As 112 Million May Have Pre-existing Conditions

Wednesday, May 16th, 2012

Between 36 million and 112 million Americans have pre-existing conditions, according to the Government Accountability Office (GAO).  Previously insurers have been able to deny coverage to sick people or offer policies that don’t cover their pre-existing conditions.  The Patient Protection and Affordable Care Act (ACA) prohibits insurers from charging higher prices to people with pre-existing conditions.

Americans with pre-existing conditions represent between 20 and 66 percent of the adult population, with a midpoint estimate of 32 percent.  The differences among the estimates can be attributed to the number and type of conditions included in the different lists of pre-existing conditions.

The GAO compared several recent studies that tried to determine how many adults have pre-existing conditions,  based on the prevalence of certain common conditions.  Hypertension, mental health disorders and diabetes are the most common ailments that lead insurers to deny coverage, GAO said.  The report doesn’t say how many of those people are presently uninsured, but the insurance industry said that number could be relatively low.  Most people have insurance through an employer that is available irrespective of pre-existing conditions, according to America’s Health Insurance Plans (AHIP).  The trade association stressed that requiring plans to cover everyone is closely linked to the individual mandate, which the Supreme Court could strike down this summer.  There is widespread agreement that the two policies must go hand-in-hand — the Obama administration told the Supreme Court that if it strikes down the mandate, it should also toss out the politically popular requirement to cover people with pre-existing conditions.

Adults with pre-existing conditions spend $1,504 to $4,844 more annually on healthcare, and the majority — 88 to 89 percent — live in parts of the country “without insurance protections similar to the Affordable Care Act provisions, which will become effective in 2014.”

GAO’s analysis found that nearly 33.2 million adults age 19-64 years old, or about 18 percent, reported hypertension in 2009.  People with hypertension reported average annual expenditures of $650, but expenditures reached $61,540.  Mental health disorders and diabetes were the second and third most commonly reported conditions.  Cancer was the condition with the highest average annual treatment expenditures — approximately $9,000.

Cost of Alzheimer’s High in Dollars and Caregiver Devotion

Tuesday, March 13th, 2012

As baby boomers age, the cost of caring for those stricken with Alzheimer’s Disease has nowhere to go but up. By 2050, the cost of treating Alzheimer’s is likely to rise from $172 billion per year in 2010 to more than $1 trillion per year in 2050.  The disease could cost Americans $20 trillion over the next few decades, according to a report from the Alzheimer’s Association.

“We saw it coming.  We knew the numbers were going to be high in the number of people getting the disease.  We as an organization have been preparing for this,” said Nancy Rainwater, vice president of communications for the Alzheimer’s Association Greater Illinois chapter.  “But to think of trillions of dollars…just the amount of money was pretty staggering.”

The statistics were calculated using an analytical model based on data from research and national surveys.  Part of the problem lies in how successful treatment has become for other diseases, Rainwater said.  “We’re living longer, so that has a lot to do with it,” she said.  “There has been so much work in other diseases – cancer, diabetes, heart disease – and people are surviving those diseases.  But then there’s a higher risk, as people age, of getting Alzheimer’s.  You look at statistics of those diseases, and the rates of death have all declined, whereas Alzheimer’s disease has increased.”

Researchers believe that the number of Americans aged 65 and older with Alzheimer’s will more than double to 13.5 million by 2050 as the population ages.  By the middle of the 21st century, nearly 50 percent of people with the disease will be in its most severe – and costly – stage.  “People in the earlier stages don’t necessarily need as much care or support,” said Darby Morhardt, social worker and research associate professor at Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center.  “But as they deteriorate, as they decline, they have more and more difficulty managing their daily care, so that care needs to be provided by someone.  Often that’s where most of the money is spent, on those last years.”

What’s most stunning is Alzheimer’s human and financial toll. According to the Alzheimer’s Association’s 2011 Facts and Figures Report, 5.4 million Americans (one in eight older Americans) suffer from the debilitating illness.  Joy Johnston of Atlanta knows how difficult caring for a parent with Alzheimer’s can be.  Her father, Patrick, like more than five million other Americans, had been diagnosed with Alzheimer’s Disease.  “It can be heartbreaking at times,” Joy said in reference to caring for her father.  “You have to relearn your relationship with your loved one.”  Caring for a family member with Alzheimer’s can take a profound financial and emotional toll.  Nearly 15 million Americans are unpaid caregivers for those sick with dementia, according to the Alzheimer’s Association.  Do the math, and it adds up to about 17 billion hours of unpaid care valued at $202 billion in 2010 alone.

To help with the staggering cost of care, the Obama Administration has included $26 million in the proposed 2013 budget.  That money will go to education, outreach and support for families affected by the disease.

“Caregivers are often in a situation where their feelings and what they have to do are in conflict,” Dr. Peter Rabins said.  “That’s very hard for most of us because we’ve related with people that we love in a certain way. The disease forces a change in that relationship.”  Rabins, the director of psychiatry at Johns Hopkins School of Medicine, notes that medical bills can pile up quickly.  “That’s a tremendous financial challenge for many families.” Rabins said.

Money isn’t the only sticking point.  The emotional costs take root as soon as dementia is diagnosed.  Family members often begin grieving a death of someone who is still physically present but disappearing mentally.  “Those feelings of loss can become quite chronic,” Rabins says.

“It’s the sort of crisis that policymakers, clinicians know is happening,” said Len Fishman, CEO of Hebrew Senior Life, the largest provider of elder care services in Massachusetts.  “I don’t think the country has absorbed it yet and in a couple of decades when the number of Alzheimer’s cases has doubled, people will look back and say,  ‘Why didn’t we know this was coming?’”

National statistics suggest that it takes an average three to four people to help care for each Alzheimer’s patient living at home; approximately 11 million Americans are currently helping to care for the estimated 70 percent of Alzheimer’s patients who are able to be at home.  That statistic does not include paid caregivers.

Although Medicaid pays for Alzheimer’s day programs for some low-income seniors; Medicare does not.  As a result, many patients and their families must pay privately for Alzheimer’s care until they’ve spent enough money to qualify for Medicaid.  Medicaid does pay for long-term nursing home care, but not the less restrictive assisted living for seniors.

Hospitals, CMS Butt Heads Over Too Many Readmissions

Tuesday, February 14th, 2012

Medicare has plans to penalize hospitals that frequently readmit patients who really don’t need hospitalization. According to one estimate, this practice costs the federal government $12 billion every year.  Medicare’s goal is to persuade hospitals to be certain that patients get the care they need following their discharge.  This new policy is likely to excessively impact hospitals, particularly those that treat low-income patients, according to a Kaiser Health News analysis of data provided by the Centers for Medicare & Medicaid Services.  Hospitals that admitted the most underprivileged Medicare patients were approximately 60 percent as likely to have significantly higher readmission rates for heart failure.  At these hospitals, lower-income people comprise a larger share of the patients than they do at 80 percent of hospitals.

“When some of our patients get home, their lights and gas are shut off,” said Roland Abellera, vice president of quality and corporate compliance at St. Bernard Hospital in Chicago’s blighted Englewood neighborhood.  “So what ends up happening is that the ambulance brings them back to us and we have to house them until our staff can help them get the utilities turned on.  We have a community in need.”

Within 30 days of discharge, 25 percent of Medicare patients with heart failure are readmitted to the hospital.  The Patient Protection and Affordable Care Act (ACA) has ruled that beginning next October, Medicare will fine hospitals whose patients who have had heart attacks, heart failure or pneumonia return to the hospital too soon.  By 2014, hospitals with high readmission rates can potentially lose up to three percent of their Medicare reimbursements.

Medicare has set aside funds so hospitals can more effectively plan patients’ post-discharge care.  According to Patrick Conway, Medicare’s chief medical officer, some funds will be targeted to hospitals that serve significant numbers of poorer people.  “We especially are concerned about safety-net hospitals that take care of a high portion of patients in poverty and racial and ethnic minorities,” he said.  At the same time, his agency is committed to the readmission penalties, in part because it is the law and because it believes the penalties will persuade hospitals to be certain that patients get the follow-up care they need.

Some hospital administrators are concerned that the new policy is too harsh.  “In essence, they are penalizing those hospitals and areas that need the most help and the most money to address these issues because we have the sickest, most noncompliant and vulnerable patient population,” said Guy Alton, chief financial officer at St. Bernard.  According to Abellera, St. Bernard’s heart failure patients usually have more than one serious conditions, such as kidney failure, hypertension and diabetes.  “A patient does not come here for heart failure alone,” he said.  “They have no less than six or seven diagnoses — we’ve had many with more than that.”

Dr. Ashish Jha, in the latest New England Journal of Medicine, makes the case that readmissions aren’t the best gauge of unnecessary care — even though they’re a natural target for budget-cutters.  The Harvard University professor points out that many hospitals with the highest readmission rates serve the poorest areas with the biggest health problems.  “Readmissions are caused by what hospitals do, who the patients are, and what’s happening in the community,” he says. “You want hospitals to fix the things they can, but you don’t want to punish them for taking care of poor people, and you don’t want to punish them for being located in a poor area.”

Two of the most frequent reasons for hospital readmissions are medication errors and failure to see a physician – both of which could be reduced if patients were supervised through home care visits following discharge.

Americans Spend More on Healthcare Than Comparable Nations

Tuesday, December 13th, 2011

The United States spends far more on healthcare than other countries, although Americans visit the doctor and are hospitalized less often than most of the other 34 member countries of the Organization for Economic Co-operation and Development OECD).  In its Health at a Glance 2011 report, the OECD shows that the United States spent about $7,960 per person on healthcare in 2009 – approximately 2.5 times the average of the countries studied.  It also determined that health spending in the U.S. has grown faster than in all other high-income OECD countries since 1970, even accounting for population growth.

“Why?” asks Julie Appleby in Kaiser Health News.  “Generally, prices for medical care are higher in the U.S. – and some services are performed more often.  Hospital prices are 60 percent higher than the average of 12 selected OECD countries, and the U.S. also generally pays more for each appendectomy, birth, joint replacement or cardiac procedure.  Americans have more imaging tests, such as CT scans and MRIs, than residents of other countries and are far more likely to have knee replacements, coronary angioplasty or surgery to remove their tonsils.  Even with all that, compared with most of the other developed countries, the U.S. has fewer practicing physicians per person, fewer hospital beds, and patients don’t stay as long in the hospital.  Administrative costs in the U.S. are also high, the report notes, accounting for about seven percent of total spending.  That is roughly comparable to what is spent in France and Germany, which have universal health coverage.  In Canada — another country with national healthcare – administrative costs are about four percent of health spending.”

“The U.S. is just this astonishing outlier compared to everyone else,” said Mark Pearson, the head of the OECD’s social policy division. A significant part of the difference relates to pricing.  American patients don’t spend more time in the hospital or visit more doctors than patients in other OECD countries; they pay more for everything.  Physician fees are more than twice the average cost, for example, while drugs and hospital care cost 60 percent more.  In terms of results, however, the U.S. does not come out on top.  Life expectancy in 2009 was 78.2 years, below the OECD average of 79.5.  That puts the nation closer to the Czech Republic and Chile, “not countries you would usually expect the U.S. to be compared to,” Pearson said.

The U.S. also has one of the poorest records in terms of premature mortality in general and mortality from heart disease in particular.  Americans have the highest obesity rate — with more than one-third of the population considered obese.  They also have one of the highest rates of hospital admission for illnesses that are optimally managed by primary-care physicians, including asthma, chronic obstructive pulmonary disease (including emphysema), and diabetes.

The news isn’t all bad.  The OECD report notes that the U.S. does an excellent job of cancer care, with very high survival rates and low mortality rates.  Stroke deaths are well below average in the United States.

Americans spend approximately 17.4 percent of its gross domestic product on healthcare; other OECD nations spend an average of 9.6 percent of their GDPs on healthcare.  According to OECD, the U.S. has an “underdeveloped” primary-care system that physician shortages only intensify.  There are 2.4 physicians for every 1,000 Americans, compared with an average of 3.1 in other countries.  Additionally, there are 3.1 hospital beds per 1,000 Americans, compared with 4.9 per 1,000 in other countries.

The Washington Post’s Ezra Klein thinks that Americans spend too much on healthcare. According to Klein, “There are a lot of complicated explanations for why American healthcare costs so much, but there are also some simple ones.  Chief among them is ‘we pay too much.’  And I don’t mean in general.  I mean specifically.  Mountains of research show that for every piece of care you might name — a drug, a doctor visit, a diagnostic — you’ll pay far more in the United States than in other countries.  That’s why seniors head to Canada to buy drugs made in the United States.  In Canada, the government negotiates one low price.  In America, insurers with much less bargaining power negotiate many higher prices.”

According to Ezekiel Emanuel, a bioethicist and fellow at the nonprofit bioethics research institute The Hastings Center, “Unfortunately, few people really understand how much we spend on healthcare, how much we need to spend to provide quality care, and the difference between the two.  Do we spend too much?  Let’s begin with the costs.  In 2010, the United States spent $2.6 trillion on healthcare, over $8,000 per American. This is such an enormous amount of money, it’s difficult to grasp.

“Consider this: France has the fifth largest economy in the world, with a gross domestic product of nearly $2.6 trillion.  The United States spends on healthcare alone what the 65 million people of France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and healthcare.  In other words, our health care spending is the fifth largest economy in the world.

“The fact is that when it comes to healthcare, the United States is on another planet.  The United States spends around 50 percent more per person than the next highest-spending countries, Switzerland and Norway.”

Foreclosure Is Hazardous to Your Health

Monday, November 14th, 2011

Falling behind on mortgage payments harms more than just finances; the stress and strain can negatively impact physical and psychological health.  In 2009, 2.2 percent of all American homes — more than 2.8 million — were in some stage of delinquency.  Researchers examined data collected in 2006 and 2008 on nearly 2,500 Americans who took part in the Health and Retirement Study, a nationally representative sample of Americans aged 50 and older.  The data included information about general health, psychological health, income and whether the person had fallen behind on paying their mortgage.  People who were behind between 2006 and 2008 reported more depressive symptoms, increased food insecurity and were more likely to not take prescription medications as prescribed because of the cost.

“People are making unhealthy trade-offs when they’re trying to make their mortgage,” said Dawn Alley, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine.  “We think it’s a very serious issue.”  The study was published in the American Journal of Public Health.

Nearly 32 percent of people who were having difficulty paying their mortgages didn’t take medications as prescribed because of costs, compared to the five percent who were able to make their mortgage payments.  “Depression, not taking medications and not spending enough money on nutritious food can exacerbate conditions you already have,” Alley said.

Nearly one-third of the people who were mortgage-delinquent reported fair or poor health compared to 19 percent who were able to pay their mortgages on time.  “The rise in mortgage defaults may have important public health implications that could ultimately prove costly to affected individuals, employers, the healthcare system, and society,” according to the study’s authors.

More than a quarter of people in mortgage default or foreclosure are over 50,” Alley said. For an older person with chronic conditions like diabetes or hypertension, the types of health problems we saw are short-term consequences of falling behind on a mortgage that could have long-run implications for that person’s health,” Alley said.

“This study has pinpointed an issue that until now has been somewhat under the radar, but which threatens to become a major public health crisis if not addressed,” said E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.  “Through research such as this, faculty epidemiologists and public health specialists provide valuable information and perspectives that are useful for government and private policy makers as they work to meet the health and economic needs of Americans.”

This study was co-sponsored by the National Institutes of Health and was conducted with support, resources and use of facilities from the Philadelphia Veterans Affairs Medical Center.

Another study by Janet Currie of Princeton University and Erdal Tekin of Georgia State University shows a direct relation between foreclosure rates and the health of residents in Arizona, California, Florida and New Jersey.  The researchers concluded in a paper published by the National Bureau of Economic Research that an increase of 100 foreclosures related to a 7.2 percent increase in emergency room visits and hospitalizations for hypertension, and an 8.1 percent increase for diabetes, among people in the 20 to 49 age group.

Writing in the Wall Street Journal, S. Mitra Kalita says that “Each rise of 100 foreclosures was also associated with 12 percent more visits related to anxiety in the same age category.  And the same rise in foreclosures was associated with 39 percent more visits for suicide attempts among the same group, though this still represents a small number of patients, the researchers say.  Teasing out cause and effect can be delicate, and correlation doesn’t necessarily mean foreclosures directly cause health problems.  Financial duress, among other issues, could lead to health problems — and cause foreclosures, too.  The economists didn’t find similar patterns with diseases such as cancer or elective surgeries such as hip replacement, leading them to conclude that areas with high foreclosures are seeing mostly an increase of stress-related ailments.”

Commonwealth Fund Tackling Better Care for Uninsured, Minorities

Tuesday, October 18th, 2011

A new strategy report issued by the Commonwealth Fund Commission on a High Performance Health System  has the goal of creating a road map to improve healthcare for the uninsured, minorities and low-income Americans.

The commission, which looks for opportunities to enhance the delivery and financing of healthcare, recommends three broad strategies for achieving that improved care in the report, Ensuring Equity:  A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations.  The recommendations seek to assure the safety net’s stability and stimulate higher performance; strengthen delivery systems for susceptible populations; and coordinate healthcare delivery systems with public health services and community resources.

“Our current economic situation has increased the number and proportion of people who are vulnerable, leaving even more families at risk of suffering from our healthcare system’s inequities,” said Dr. David Blumenthal, chairman of the commission, and Samuel Their, professor of medicine and professor of health care policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Boston.

According to the report, there is a significant divide between vulnerable populations and their more secure counterparts in rates of receiving recommended screening and preventive care, control of chronic diseases, and hospital admissions for conditions that may be preventable with good primary care and community health outreach.  By way of example, only four of 10 low-income adults receive all recommended screenings and preventive care, compared with six of 10 higher-income adults.  Approximately three of 10 (29 percent) uninsured adults diagnosed with diabetes do not have it under control, twice the rate of the insured (15 percent).  Black adults are hospitalized for heart failure at rates (959 per 100,000) that are more than twice the rate for Hispanic adults (466 per 100,000); that’s nearly three times the rate for white adults (349 per 100,000).

“This policy framework builds on the great strides we expect to be made for vulnerable populations once the Affordable Care Act takes full effect in 2014,” said Commonwealth Fund Executive Vice President for Programs Anthony Shih, M.D. “By addressing crucial issues like access to care, affordability, quality improvement, and better coordinated care, these recommendations seek to assure that the uninsured, those with low incomes, and racial and ethnic minorities see the full promise of health reform and experience a truly equitable healthcare system.” 

“The Affordable Care Act is a big step forward in terms of addressing the significant needs of vulnerable groups and the healthcare providers who serve them,” said Commonwealth Fund President Karen Davis. “However, the inequity in our healthcare system is significant and” as defined in the Commission’s report, “more work must be done to close that gap and assure that we have a healthcare system that provides all of us with access to high quality healthcare.”

HHS Sets New Guidelines for Women’s Health Services

Monday, August 29th, 2011

The Department of Health and Human Services (HHS) has announced new guidelines requiring health insurance plans to cover several women’s preventive services on or after August 1, 2012.  Among the inclusions are contraception and voluntary sterilization.  According to HHS Secretary Kathleen Sebelius the decision is a result of the Affordable Care Act’s (ACA) efforts to prevent problems before they start.  “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” she said.  The Institute of Medicine (IOM) conducted a scientific review of women’s health needs and gave recommendations on specific preventive measures; HHS has now approved those recommendations.

“Today, as part of the Affordable Care Act, we are announcing historic new guidelines that will help women get the care they need to stay healthy,” Sebelius said. “Today we are accepting the recommendations of the Institute of Medicine, so no woman in America needs to choose between paying a grocery bill and paying for the key care that can save her life.”

The new rules are one of the broadest and potentially popular provisions of the ACA. “Since birth control is the most common drug prescribed to women ages 18 to 44, insurance plans should cover it,” Sebelius said. “Not doing it would be like not covering flu shots.”  The new rules also apply to annual “well-woman” checkups; screening pregnant women for diabetes; DNA testing every three years for human papillomavirus (HPV) — which can cause certain cancers in women 30 years and older; annual screening and counseling for HIV; counseling to determine whether a woman is at risk for other sexually transmitted diseases; breast-feeding support, counseling and supplies including breast pumps; yearly screening and counseling for domestic violence; and sterilization methods.

Howard Koh, MD, HHS assistant secretary for health, estimated that by 2013, 34 million women between the ages of 18 and 64 will receive the benefits detailed in the new ruling.  Although preventive care saves money by avoiding or delaying more costly chronic disease care, Koh said the new benefits will involve a “small” increase in premium costs.

Stephanie Cutter, a deputy senior advisor to President Obama, said that, “As a result of the Affordable Care Act, the new health reform law, insurance companies have to provide preventative care with no out-of-pocket costs.  There were never any guidelines for women’s health to make sure they stay healthy throughout the course of their lives.  Today, that’s no longer the case.  We have a set of recommended preventative services for women.  Private insurance companies,” Cutter said, “have to provide the services with no out-of-pocket costs.  Many of the benefits we’re announcing today are already part of large private healthcare care, employer plans, and they’re part of federal health care benefits.  Members of Congress have the benefits. Now, they’re going to be available to all women.”

“For women’s health, this is historic — a really important turning point,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center.  At present, women pay as much as $50 a month for birth control pills, even if they have insurance coverage, said Dr. Allison Cowett, director of the Center for Reproductive Health at the University of Illinois at Chicago Medical Center.  For many women, this is a financial hardship and a disincentive to practice consistent birth control.  Fully 95 percent of women who have unplanned pregnancies report using contraception only occasionally or never — often because it’s too expensive, according to the Guttmacher Institute, a nonpartisan research organization.  Birth control has been shown to improve maternal and child health, in addition to reducing unwanted pregnancies and abortions.

The guidelines, which would compel insurance companies to cover costs and eliminate co-pays and deductibles, have their critics. Birth control has been controversial since Margaret Sanger opened the United States’ first family planning clinic in 1916 — and ended up in prison for it. While many believe that contraception is the best method to prevent unwanted pregnancies, others support abstinence education. The United States Conference of Catholic Bishops opposes the new guidelines, saying, “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”  Women’s rights advocates argue that the benefits of free birth control have uses other than preventing pregnancy. “The number of children we have determines how many we need to educate, how many we need to employ,” says Roosevelt Institute Senior Fellow Ellen Chesler.  “The social and economical outcomes of contraception are critical.”

The new guidelines will not apply to religious institutions that offer health insurance to employees.  Not surprisingly, health insurers also oppose the rules.  The Institute of Medicine counters that the “direct medical cost of unintended pregnancy in 2003 was $5 billion, with a savings from contraception that year estimated at $19.3 billion.  With nearly half of pregnancies unintended, there’s quite a bit of room to save money with free contraception.”  One estimate of the cost of birth control for women is between $3,600 and $18,000 over a lifetime, depending on insurance, the form of contraception and other factors.

Poor Education Can Lead to Alzheimer’s

Monday, August 8th, 2011

As many as 50 percent of Alzheimer’s cases worldwide could be avoided if risk factors such as depression, obesity and smoking were eliminated, either with lifestyle changes or treatment of underlying conditions.  Even modest cuts in the level of risk factors could prevent millions of cases of the memory-robbing illness, the researchers said.  As an example, a 25 percent cut in seven common risk factors – such as poor education, obesity and smoking — could prevent as many as three million Alzheimer’s cases around the world and up to half a million in the United States alone.  The new research is being presented at the Alzheimer’s Association International Conference (AAIC) and published online in The Lancet Neurology.

“The idea here is to get a better bead on exactly how we can start untangling what the risk factors are, so that we can not only treat and modify Alzheimer’s but also start talking about prevention of Alzheimer’s,” said Mark Mapstone, associate professor of neurology at the University of Rochester Medical Center.  “The field is working very hard (to figure out) what these risk factors are so we can start heading this disease off before it starts.”

Led by Deborah Barnes of the University of California San Francisco (UCSF), the researchers revisited earlier epidemiological studies on links between Alzheimer’s and seven vital risk factors: poor education, smoking, low physical activity, depression, hypertension during mid-life, obesity and diabetes.  They estimated that these risk factors account for 17 million cases of Alzheimer’s worldwide (approximately half of the estimated 34 million cases of dementia globally) and three million of the 5.3 million estimated cases in the United States.  Some factors appeared to have a greater impact on Alzheimer’s risk than others.  The UCSF team estimated that worldwide, 19 percent of Alzheimer’s cases can be attributed to low education; 14 percent to smoking; 13 percent to physical inactivity; 10 percent to depression; five percent to mid-life hypertension; 2.4 percent to diabetes; and two percent to obesity.  In the United States, more than 20 percent of cases can be traced to low physical activity; 15 percent to depression; 11 percent to smoking; eight percent to mid-life hypertension; seven percent to mid-life obesity; seven percent to low education and three percent to diabetes.

Dr. Ronald Petersen of the Mayo Clinic said the findings have important public-health implications and will help raise awareness of the need for prevention.  The study offers “an uplifting message for aging and cognition,” he said, insofar as it suggests that lifestyle factors can be modified to alter Alzheimer’s risk, at least at the societal level.  But, with the exception of increasing physical activity, there is scant evidence that interventions are successful in altering an individual’s chances of developing Alzheimer’s.

Other studies have shown that increasing physical activity is effective.  But whether taking up crossword puzzles or losing weight impacts the path of Alzheimer’s — the pathology of which seems to begin years before symptoms appear — remains unknown.  Last year, a National Institutes of Health panel concluded – with some controversy — that the scientific evidence on lifestyle factors was negligible and said that intervention is helpful.  Petersen said that, while depression is clearly associated with Alzheimer’s, the causal direction could go either way, especially when the depression comes late in life.  “Is that really a risk factor for, or a function of, the disease?” he asked.  The question is, for the most part, irrelevant from a clinical perspective because depression should be treated anyway, Petersen said.

“Education, even at a young age, starts to build your neural networks,” so being deprived of it means poorer brain development, Barnes said.

“It gives us a little bit of hope about things we could do now about the epidemic that is coming our way.”  Alzheimer’s cases are expected to triple by 2050, to approximately 106 million globally.  “What’s exciting is that this suggests that some very simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a tremendous impact on preventing Alzheimer’s and other dementias in the United States and worldwide,” Dr Barnes said.

The study could be good news for people – usually family members – who are caregivers for individuals with Alzheimer’s. “Throughout the progression, I felt quite helpless…without any cure for (Alzheimer’s disease) yet, I could only watch,” said Rick Lauber, who acted as caregiver to his father, John, who developed the disease in his 60s and died at age 76.  As his father’s caregiver, Lauber had to take on unexpected responsibilities, such as moving him three times, taking him to doctor’s appointments, paying bills and becoming his father’s Joint Guardian and Alternate Trustee.  “As an adult child and a family caregiver, caring for Dad had to one of the hardest things imaginable,” Rick Lauber said.  “Watching him decline from a healthy, active, respected academic to a shell of a man was very challenging.  Dad was changing before my eyes and I could not do anything about this.”

According to the 2011 annual Facts and Figures release from the Alzheimer’s Association, nearly 15 million Americans provide 17 billion hours of unpaid care worth $202 billion every year.

This blog is dedicated to the memory of William A. Alter, the founder of our company who passed away August 8, 2008 of complications of Alzheimer’s disease.  To read about Bill Alter’s amazing career, please click here.

New Study Ranks Healthiness in the Nation’s 3,016 Counties

Tuesday, April 19th, 2011

A study led by the Robert Wood Johnson Foundation has ranked the level of healthiness in the more than 3,000 counties that comprise the United States. Conducted with the assistance of the University of Wisconsin’s Population Health Institute, the study entitled “County Health Rankings: Mobilizing Action Toward Community Health,” provides a snapshot of where America’s healthiest people live.

“This is a complicated story about what makes a community healthy and another not so healthy,” said report author Pat Remington, the associate dean for public health at the University of Wisconsin.  For example, researchers point to cities reputed for their top-quality medical centers – most notably Baltimore and Philadelphia — that ranked close to the bottom in their respective states.  “Social, economic and health habits may be at play there,” said James Marks, senior vice president and director of the foundation’s health group.

The researchers examined federal and state health-related data on 3,016 counties, according to Remington.  The information was analyzed by researchers who had created similar reports for the state of Wisconsin over the past six years.  Remington said   his group wanted to “bring it down to the ground level” by learning where strengths and weaknesses lie within individual counties.

Each county is examined in two ways:  “Health Outcomes” and “Health Factors.”  “Health Outcomes” look at a county’s disease and death rates.  The “Health Factors” rating is more complicated and examines such factors as obesity rates, smoking and alcohol use.  Socio-economic factors, such as unemployment, income and safety, also are considered in addition to access to healthcare and the local environmental.  “The ‘Health Outcomes’ rank is about current healthiness factors.  The ‘Health Factors’ rank is about where they are going — predictors of health,” Marks said.

Some of the results are eye-opening. The healthiest of Illinois’s 102 counties is Kendall, which is located next to LaSalle County, which ranked 65th.  LaSalle County, whose smoking rate is twice the national average, is home to twice as many people who can be considered to be in fair to poor health.  The divide between suburban and rural also comes into play here.  Kendall County is close enough to Chicago be almost be considered part of the metropolitan area, while LaSalle County is rural and home to many farms.  According to Dr. Remington, “Affluent suburbs tend to have higher-paying jobs, often in the cities, whereas rural communities often are dealing with loss of business.”  Rural populations also are in decline as younger and healthier people move away from places like LaSalle County to the cities where employment opportunities are more varied.  To improve the health of its citizens, LaSalle County health department officials are giving nicotine patches to smokers and educating school officials about obesity and diabetes.

“It’s hard to lead a healthy life if you don’t live in a healthy community,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.  “The County Health Rankings are an annual check-up for communities to know how healthy they are and where they can improve.  We hope that policymakers, businesses, educators, public health departments and community residents will use the Rankings to develop solutions to help people live healthier lives.”